Topics in Geriatrics: Health Literacy in the Geriatric Population While health literacy is an important topic for all populations, it is especially relevant for the older, geriatric population. With healthcare utilization and pharmacology increasing with age, heath literacy becomes highly important for managing instrumental activities of daily living and even preventing death.
Objectives: The objectives of this page are:
To understand what health literacy is
To understand the connection between health literacy, polypharmacy, and medication management
To understand the effect of health literacy on mortality
To outline some potential ways to improve health literacy and medication management in the geriatric population
Information about Health Literacy: What is health literacy? As defined by Aaron Findley, health literacy is “the ability to understand health-related information.” Additionally, Mitty and Flores define health literacy as “understanding health information and then acting on it.”1 There are many definitions of health literacy, but to put it simply, health literacy is an individual’s ability to (1) understand the language surrounding his or hers health care, and to (2) make informed decisions concerning his or her care.
Connection between health literacy, polypharmacy, and medication management Older adults aged 65 years or older are among those with the lowest health literacy and unfortunately, many healthcare providers tend to overestimate the health literacy of their patients.1,2 In addition, many older adults have chronic diseases which require multiple medications to be taken at multiple time points throughout the day.3 A study by Pasina et al. showed that the more medications prescribed at discharge and the more complicated the medication schedule (e.g. taking medications 1x throughout the day v. taking mediations 3x throughout the day), the poorer medication compliance. In fact, they found a direct relationship between the number of drugs prescribed at discharge and medication non-adherence after 15 days, 30 days, and 3 months. On the other hand, they also found higher adherence rates in those patients taking medications 1x throughout the day when compared to those taking medications multiple times throughout the day.3 Interestingly, Pasina et al. found no relationship between medication adherence and demographic variables (e.g. age, sex, marital status, etc.).3
With all of this in mind, it is imperative that health care practitioners investigate the health literacy of all of their patients. Failure to recognize a patient with low health literacy may result in prescription of complex and difficult to understand health care education and medication prescription instructions.2 Given these complex instructions have been associated with higher rates of non-adherence, adverse reactions, poorer quality of life, greater economic burden, and greater caregiver depression, health care providers must take the time to evaluate health literacy in all patients without making assumptions.
Health literacy and mortality While health literacy may have been previously considered just another interesting detail about that patient for some practitioners, it must become a priority for all health care practitioners. In a paper from the American Heart Association, researchers found low health literacy rates to influence mortality by way of disease management.2 Additionally, Mullen found those with limited health literacy to have higher risks for mortality, even after taking into consideration other confounding variables (e.g. socioeconomic status, comorbidities, access to health care, etc.).4 Perhaps the most striking statistics have been shown by Pasina et al. when they found high 3-month mortality rates following discharge in patients with low health literacy.3
Health literacy is not simply another detail that enters the patient’s chart never to be seen again, it must be at the forefront of all treatments. It influences all aspects of a patient’s health care experience, the health care system as a whole (lower health literacy is associated with increased health care costs), and even a patient’s ability to survive.3
Improvement in health literacy to enhance medication management Luckily, there are many different things health care providers can do to better address low health literacy rates. In addition to providing educational information to patients at a level they can understand, there are other materials and strategies health care practitioners can employ.
First, it is known that the complexity of patient instructions (e.g. medication schedule) and poor communication by the health care practitioner are common causes of medication non-adherence, particularly in older populations with comorbidities such as memory disorders.3 Of course it makes sense that if a patient cannot follow the instructions provided to them, they will have much difficulty following those instructions. This means as health care practitioners, we must make our instructions and explanations simpler so the patient is able to follow along.3
Secondly, if that person does not understand the importance of taking a particular medication or starting a new behavior, that person will also be unlikely to follow through with the instructions from the health care provider. Essentially if the patient does not care about a particular instruction, he or she will be unlikely to follow through. This essentially means it is imperative providers tie their recommendations to the patient’s values, and consider individual personal barriers when making those recommendations.
Finally, written instructions can be difficult to follow and patients may have an easier time understanding picture or video representations of the material. Martin et al. found that using picture representation of medication schedules via PictureRx significantly improved medication-related self-efficacy and adherence in community-dwelling older adults.5 Essentially, health care providers must consider the patient’s health literacy level, learning preference, and personal values when tailoring optimal recommendations.
With all of these things in mind, here are some suggestions for health care providers to enhance patient adherence:
Make explanations and instructions clear so the patient understands the information provided
Use the teach-back method and ask open-ended questions to ensure the patient understands the materials presented
Consider providing the patient with a picture representation of their instructions (e.g. using PictureRx for medication schedule; pictures of exercises for home exercise program, etc.)
Consider enlisting the help of family members to better re-inforce healthy behaviors and medication management3
Incorporate patient values, preferred learning style, and personal barriers into treatment recommendations
Fast Facts
Those 65 or older have the smallest percentage of people with proficient health literacy skills and the largest percentage with below basic health literacy skills1
Older adults with diabetes, high cholesterol, and hypertension are nearly two times as likely to have low health literacy1
42% of older adults read at less than a 6th grade level5
Lower health literacy is associated with increased risk of death after hospitalization for acute heart failure2
Healthcare providers often overestimate the health literacy skills of their patients2
Findley A. Low Health Literacy and Older Adults: Meanings, Problems, and Recommendations for Social Work. Social Work in Health Care. 2015;54(1):65-81. doi:10.1080/00981389.2014.966882.
Mullen E. Health Literacy Challenges in the Aging Population. Nursing Forum. 2013;48(4):248-255. doi:10.1111/nuf.12038.
Pasina L, Brucato AL, Falcone C, et al. Medication Non-Adherence Among Elderly Patients Newly Discharged and Receiving Polypharmacy. Drugs & Aging. 2014;31(4):283-289. doi:10.1007/s40266-014-0163-7.
McNaughton CD, Cawthon C, Kripalani S, et al. Health Literacy and Mortality: A Cohort Study of Patients Hospitalized for Acute Heart Failure. Journal of the American Heart Association. 2015;4(6):1-9. doi:10.1161/jaha.115.000682.
Martin D, Kripalani S, Durapau V. Improving Medication Management Among At-Risk Older Adults. Journal of Gerontological Nursing. 2012;38(6):24-34. doi:10.3928/00989134-20120509-01.
While health literacy is an important topic for all populations, it is especially relevant for the older, geriatric population. With healthcare utilization and pharmacology increasing with age, heath literacy becomes highly important for managing instrumental activities of daily living and even preventing death.
Objectives:
The objectives of this page are:
Information about Health Literacy:
What is health literacy?
As defined by Aaron Findley, health literacy is “the ability to understand health-related information.” Additionally, Mitty and Flores define health literacy as “understanding health information and then acting on it.”1 There are many definitions of health literacy, but to put it simply, health literacy is an individual’s ability to (1) understand the language surrounding his or hers health care, and to (2) make informed decisions concerning his or her care.
Connection between health literacy, polypharmacy, and medication management
Older adults aged 65 years or older are among those with the lowest health literacy and unfortunately, many healthcare providers tend to overestimate the health literacy of their patients.1,2 In addition, many older adults have chronic diseases which require multiple medications to be taken at multiple time points throughout the day.3 A study by Pasina et al. showed that the more medications prescribed at discharge and the more complicated the medication schedule (e.g. taking medications 1x throughout the day v. taking mediations 3x throughout the day), the poorer medication compliance. In fact, they found a direct relationship between the number of drugs prescribed at discharge and medication non-adherence after 15 days, 30 days, and 3 months. On the other hand, they also found higher adherence rates in those patients taking medications 1x throughout the day when compared to those taking medications multiple times throughout the day.3 Interestingly, Pasina et al. found no relationship between medication adherence and demographic variables (e.g. age, sex, marital status, etc.).3
With all of this in mind, it is imperative that health care practitioners investigate the health literacy of all of their patients. Failure to recognize a patient with low health literacy may result in prescription of complex and difficult to understand health care education and medication prescription instructions.2 Given these complex instructions have been associated with higher rates of non-adherence, adverse reactions, poorer quality of life, greater economic burden, and greater caregiver depression, health care providers must take the time to evaluate health literacy in all patients without making assumptions.
Health literacy and mortality
While health literacy may have been previously considered just another interesting detail about that patient for some practitioners, it must become a priority for all health care practitioners. In a paper from the American Heart Association, researchers found low health literacy rates to influence mortality by way of disease management.2 Additionally, Mullen found those with limited health literacy to have higher risks for mortality, even after taking into consideration other confounding variables (e.g. socioeconomic status, comorbidities, access to health care, etc.).4 Perhaps the most striking statistics have been shown by Pasina et al. when they found high 3-month mortality rates following discharge in patients with low health literacy.3
Health literacy is not simply another detail that enters the patient’s chart never to be seen again, it must be at the forefront of all treatments. It influences all aspects of a patient’s health care experience, the health care system as a whole (lower health literacy is associated with increased health care costs), and even a patient’s ability to survive.3
Improvement in health literacy to enhance medication management
Luckily, there are many different things health care providers can do to better address low health literacy rates. In addition to providing educational information to patients at a level they can understand, there are other materials and strategies health care practitioners can employ.
First, it is known that the complexity of patient instructions (e.g. medication schedule) and poor communication by the health care practitioner are common causes of medication non-adherence, particularly in older populations with comorbidities such as memory disorders.3 Of course it makes sense that if a patient cannot follow the instructions provided to them, they will have much difficulty following those instructions. This means as health care practitioners, we must make our instructions and explanations simpler so the patient is able to follow along.3
Secondly, if that person does not understand the importance of taking a particular medication or starting a new behavior, that person will also be unlikely to follow through with the instructions from the health care provider. Essentially if the patient does not care about a particular instruction, he or she will be unlikely to follow through. This essentially means it is imperative providers tie their recommendations to the patient’s values, and consider individual personal barriers when making those recommendations.
Finally, written instructions can be difficult to follow and patients may have an easier time understanding picture or video representations of the material. Martin et al. found that using picture representation of medication schedules via PictureRx significantly improved medication-related self-efficacy and adherence in community-dwelling older adults.5 Essentially, health care providers must consider the patient’s health literacy level, learning preference, and personal values when tailoring optimal recommendations.
With all of these things in mind, here are some suggestions for health care providers to enhance patient adherence:
Fast Facts
Clinician Resources
References: